Healthcare Provider Details

I. General information

NPI: 1790738284
Provider Name (Legal Business Name): LOGAN HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HERITAGE WAY
KALISPELL MT
59901-3146
US

IV. Provider business mailing address

200 HERITAGE WAY
KALISPELL MT
59901-3146
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-3950
  • Fax: 406-756-3957
Mailing address:
  • Phone: 406-756-3950
  • Fax: 406-756-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM GIBSON
Title or Position: GENERAL COUNSEL
Credential:
Phone: 406-752-1724